MEDICARE: DR. ANNE N DIEDRICH PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	006147	AZ

General Provider Information

NPI Number	:	1285262832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE N DIEDRICH PT, DPT

Provider Business Mailing Address
First Line	:	2902 E EASTLAND ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-5761
Country	:	US
Telephone Number	:	520-955-3523
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 S LANGLEY AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1036
Country	:	US
Telephone Number	:	520-955-3523
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	05/05/2020

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